Peri-Implantitis : Any Solutions?

Dr. R. asks:

This is the first case I have done where I placed the dental implant on the day I extracted the tooth. This was in #14 area [Maxillary Left First Molar]. There were problems right from the beginning.

Now after 4 months post-op the upper 2 threads of the implant are visible and exposed to the oral cavity. I believe the dental implant has peri-implantitis. Is there anything I can do at this point to save this dental implant? Additionally, what causes peri-implantitis and how can I prevent it in the future?

23 thoughts on “Peri-Implantitis : Any Solutions?

  1. I feel it would be best to remove the implant and bone graft with FDDBM allow 4 mothths for regeneration and the place another implant allow another 4 months before loading.

  2. I agree with Dr. Callan. Why are we dentists allowing the public or certain implant manufacturers to push us around and demand “teeth in an hour”?

    In the case of a maxillary molar being extracted immediately and replaced with an implant……where do you place the implant, the socket generally has at the time of extraction three separate holes….where can you ideally place an implant when all of the three holes are off- center.

    I am rapidly becoming disenchanted with immediate loading, and feel that after a natural tooth is removed, allow some time for pathogens that you cannot see, disappear, and even wait for primary closure of the soft tissue before doing a bone graft.

    Placing an implant into good healthy bone, will help achieve a good final result……take your time, and remember the old saying “haste makes waste”.

    Gerald Rudick dds Montreal

  3. loose the implant, graft, replace with an endopore , wait and restore. There is nothing else to do really. A good closure will give you a better terrain for osseointegration and a good attched gingiva will give nice contours and stable aesthetics.
    luck

  4. The implant will probably “unscrew” if it has only been in 4 months. Graft and wait at least 4 months and place at least a 10 mm long x 5 mm implant depending upon occlusal scheme. Don’t try to graft the threads and manipulate soft tissue etc. Your chance for success if verey, very low.
    Thanks for sharing and best of luck to you.

  5. Dr.Berg
    Why ONLY ENDOPORE?
    If there is sufficient bone height after graft, then there are many other good implants are available.

  6. Dr. R
    Not enough data. What was the status of #14 at time of extraction?
    Is the paient healthy? Will they accept a second procedure?
    What was the size of the root form placed?
    What was the condition of the crestal bone to start with?
    How deep did you place the implant?
    Was any of the cover screw exposed to the oral cavity during healing?
    Might it been in function from the start?
    What was the bone height after placement and shortly there after?
    The etiology of peri implant disease is questionable. It certainly envolves microbia, but that may not be the etiology. The microbes could also be or MAYBE a complication of damage to the implant body, like a crack, and the bacteria are secondary to stress and deformation.
    Do you see signs of inflamation?
    Is the implant firm?
    Do you see superation?
    Perhaps one could load the root form in a provisional and observe what happens. Since you are not in the esthetic zone where its very critical this may be a good thought. If the implant is firm and the rest is integrated it may not be a rule to remove it with two exposed threads if it stays stable from here durng function in a provisional…

  7. I feel it is not possible to place an immediate implant into a molar extraction site and not necessary. Too little retention and too big of a hole. Stick to what works. extract, wait 2+ months, implant, with cover screw or soft tissue abutment, cook for 4 -6 months and then restore. 96% success. happy patients and more implants from referrals. Good luck.

  8. Nice comments, but why not using the bone that is there? It is possible with new implant design. Try immediate placement of a Southern Coaxis implant in the palatal socket. Works great, if you come out in the center. The other option is a Southern MAX implant – AO innovation award winner. Comes in 8 amd 9mm diameter and from 7mm up to 11mm tapered. Decreased grafts and complications significantly. I can treat 80% of my molar extractions with immediate placement, wait 3 months only, never lost any of over 150 Coaxis or MAX. Was a Nobel Gold customer, switched to Southern Implants, best decision I ever made!

  9. I agree with the concept that waiting on molars is prudent and good implant dentistry. I dont agree that placing an implant in a palatal socket is wise and I think in fact is poor judgement. That is an off axis implant in a molar site under the masseter. How can you possibly load that one axially? Remember he palatal root is part of the root SYSTEM of that molar. Plus that bone is usually type 3 at best there. Graft wait and reenter in 4-5 months. And you may even have to graft again with a localized Summers lift or expand to get the bone you need above the implant where the interradicular floor was at the time of extraction. That is more predictable than the course you are taking now. Proper placement would most likely require one or the other and maybe both. Waiting will also give you some great tissue for primary closure. And I am all for predictability. If you follow Dr. Callan’s posts, he provides comments that are all literature based and common sense based. With our best efforts, we will all have failures from time to time, but I rapidly steered away from what I call the “maybe-I-Can-get-this-to-work” category after a dismal failure. Back to basics. Bill

  10. OK, I’m a mini implant fan, and I’ve been wanting to ask this question for a while. Why not place three 2.5mm minis in each of the three sockets, a few mm longer than the existing tooth roots. Off axis is fine, just connect the three mini’s with some sort of splinting device to prevent mobility during healing. I have different ways I have splinted but that’s another discussion. Immediate load if desired with a conventional crown and bridge temp technique. Wait a few months for permanent crown to be conservative – or not.

  11. Above post continued – hit the wrong key. Anyway this method gives you primary stability in exactly the same planes as the original tooth. The sinus is avoided just like the original tooth “straddles” the sinus. Grafting of any kind will be unnecessary because the mini is narrow enough to avoid exposure on the palatal or buccal sides. Surface area of three minis is significantly greater than surface area of even a large conventional implant. And since forces are distributed in different directions during mastication, breakage should not be a factor. Where is this thinking wrong?

  12. Dr. Wood’s comment is well taken and one way to go. The problem with waiting is that bone may resorb and grafting will be necessary. Nothing wrong with grafting. According to Cochrane reports

  13. Dr. Wood’s comment is well taken and one possible way to go. The problem with waiting is that bone will resorb and grafting may become necessary. According to Cochrane reports and my personal experience complication rates increase. Even as an OMFS – whenever possible, I try to avoid grafting.
    An angulated implant is no problem as long the abutment junction is not overloaded – this is the unique Coaxis feature (German patent), originally designed for upper incisors. Nobel’s all on four are angulated and work.
    The MAX concept is using 7mm long and 8mm or 9mm diameter implants. They come up to 11mm as well. If primary stabile, they work excellent, as one 7mm implant has more bone contact surface as one 4x13mm implant. If this all fails, you can do the graftings anyway.
    My patients prefer one stage procedures. I can offer this in 70% of molar extractions. See – old Europe is open to innovations … Alex

  14. ALEX,

    You sound like you would make a better sales representative than a doctor. If you are even a doctor and not a sales representative already for this mysterious Southern Implants the “AO innovation award winner”.
    This is a site for doctors to have clinical discussions with their colleagues not for sales representatives to tell doctors to “TRY immediate placement of a Southern Coaxis implant in the palatal socket. Works great” Please do your job the old fashion way, the ethical way. Work hard. Go door to door. Dont they do that anymore in Virgina?

    RR

  15. Richard,

    The company itself is from South Africa. They have some local business in Virginia here in the US. I met the representative once. She should not be on here soliciting.

    RR

  16. I typically enjoy reading this site for the insight I receive, but cannot believe the slander I just read. The ITI Rep-RR’s privelages should be revoked from using this site.

    I am the actual Virginia sales representaive for Southern Implants and if anyone has any questions regarding Southern Implants, please contact our Irvine, CA-US based facility at 866-700-2100 or me directly at 703-297-1472 to receive correct information. And Richard, I am the one who can supply you with that.

    As the ITI Rep-RR said “this is a sight for doctors to have clinical discussion with there colleagues” and with that in mind, I will not take any more of your valuable time.

    Sharon

  17. I WOULD LIKE TO SAY THAT IT IS NOT ETHICAL TO PLACE ANY IMPLANT THAT HAS AN EXTERNAL OR INTERNAL IMPLANT-ABUTMENT CONNECTION. THERE IS ONLY ONE WAY, MORSE-TAPER CONNECTION BETWEEN ABUTMENT AND IMPLANT. ACCORDING TO THE LATEST LITERATURE BY LEADING UNIVERSITIES, THE MAIN REASON FOR PERI-IMPLANTITIS AND BONE LOSS AROUND IMPLANTS, IS THE MICRO-GAP BETWEEN ABUTMENT AND IMPLANT. SINCE I CHANGED TO A MORSE-TAPER IMPLANT SYSTEM MY LONG TERM SUCCESS RATE HAS IMPROVED DRAMATICALLY. THEO. SOUTH AFRICA

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